Gynecologic cytology pearls surfaced on X
Two cytopathologists posted practical morphologic notes this week—'Bag of Polys' (intracytoplasmic PMNs) as a feature of endometrioid endometrial adenocarcinoma even in peritoneal washings, and detailed images/criteria separating serous borderline tumor with <5 mm stromal microinvasion from microinvasive low‑grade serous carcinoma. Those image-based nuances matter for reporting washings and adjudicating borderline ovarian tumors. ( )
Syed Z. Ali, MD, listed as Director of the Division of Cytopathology at Johns Hopkins, is an active X (formerly Twitter) educator with an account that analytics sites estimate at ~14,300 followers. ( ) (profiles.hopkinsmedicine.org) Textbook and teaching resources note that intracytoplasmic neutrophils (“bag of polys”) are a documented cytologic feature of endometrioid endometrial carcinoma but can also appear with reparative/reactive change on pelvic specimens. ( ) (pathologyoutlines.com) The 2020 WHO/ICCR criteria used in surgical pathology define stromal microinvasion in serous borderline tumours as foci not exceeding 5 mm in greatest linear dimension (or 10 mm2 area), a threshold repeatedly cited in recent reviews of SBT reporting. ( ) (pathologyjournal.rcpa.edu.au) Pathology image repositories and series estimate stromal microinvasion occurs in roughly 10% of serous borderline tumours, and multiple clinical analyses conclude that isolated stromal microinvasion (<5 mm) without invasive extra‑ovarian implants usually does not independently predict worse recurrence. ( ) (webpathology.com) Recent reviews of pelvic/peritoneal cytology highlight wide variability in malignant cytology rates (reported 4.9%–40% across series) and recommend interpreting washings alongside histology, staging, and adjunctive cell‑block/IHC (e.g., WT1, L1CAM) when available to reconcile image-based nuances demonstrated in educational X threads. ( ) (acsjournals.onlinelibrary.wiley.com)
